Background
The groin is the site of metastasis in approximately 15-18% of melanoma of the trunk and lower limb. Superficial groin dissection remains standard of care and carries a significant morbidity rate. In order to minimize the morbidity of radical groin dissection, a minimally invasive approach has been described (video endoscopic inguinal lymphadenectomy: VEIL). VEIL has been shown to be safe with adequate oncologic results. More recently, robotic-assisted video endoscopic inguinal lymphadenectomy (RAVEIL) has been successfully described for urologic malignancies. This study is a limited clinical series comparing VEIL and RAVEIL in cutaneous melanoma patients.
Materials and Methods
Our series reviewed six patients that underwent minimally invasive inguinal lymphadenectomy between 1/1/2011 and 1/1/2016. Patient characteristics and surgical indications were analyzed. Patient charts were reviewed for perioperative adverse events, conversion to unplanned procedure, complications, pathologic outcomes, length of stay, and melanoma recurrence.
Results
Three patients had undergone VEIL and three had RAVEIL. The average age of patients was 61. Indications for VEIL were positive sentinel node in 1 patient and delayed recurrence of limb melanoma of unknown origin in one patient. Indications for RAVEIL were positive sentinel node in 2 patients, and delayed groin recurrence in one patient. There were no intraoperative complications or conversions to open. All patients were discharged on postoperative day 1. Two patients in the VEIL group had a seroma managed with aspiration and one patient in the RAVEIL group had cellulitis with seroma managed conservatively. One patient in the RAVEIL group had a limited skin necrosis managed conservatively. One patient in each group had limited lymphedema. Median lymph nodes yield from VEIL was 5 and 9 for the RAVEIL. Two patients in the VEIL group had local recurrence: one above the inguinal ligament 6 months after procedure and one above the Scarpa’s fascia 10 months later. No recurrence has been shown in the RAVEIL group.
Conclusions
Minimally invasive approach to the groin for melanoma has limited morbidity with very limited impact on patient quality of life. Both VEIL and RAVEIL are safe procedures. While it is too early to draw conclusions in term of oncologic results, RAVEIL appears definitely to be more effective in nodal dissection in terms of removing the Scarpa’s fascia and dissection above the inguinal ligament.